The reason I was fooled was because the events (which turned out to be imaginary delusions) appeared as perceptually convincing as they would if they were real. This is exactly the way delusions (false beliefs) and hallucinations (false perceptions) appear and feel to people with schizophrenia—perceptually, they have the same physical qualities as real events and images. Imagine if someone was holding a carnation and a rose, and insisting that one was real but the other was a figment of your imagination—how could you possibly decide which was which? A Beautiful Mind manipulates the perceptual qualities of cinema to evoke an experience that is vivid yet unreliable in a manner that is parallel to the experience of people with schizophrenia.18
Representations of Psychologists and Psychological Treatment
Gabbard and Gabbard's Psychiatry in the Cinema (1999) is a comprehensive examination of the many ways that psychiatry, psychology, and psychoanalysis have interacted with film.19 Their index lists over 450 feature films, from 1906 (the amusingly titled Dr. Dippy's Sanitarium) to 1998, representing mental health treatment providers.20 Clearly Hollywood has a fascination with psychotherapy and psychotherapists.21
Gabbard and Gabbard's historical analysis of the representation of cinematic mental health professionals highlights how attitudes change over time. In the early days of film up through World War II, psychiatrists were portrayed in a blatantly unrealistic manner. Often they were depicted as quacks, using satire to deflate medical pompousness (as in the silent Dr. Dippy's Sanitarium and the classic screwball comedy Bringing Up Baby). In the 1940s and 1950s, films became increasingly serious in their treatment of psychoanalysis, culminating with the late 1950s and early 1960s, referred to as the Golden Age of psychiatry in the movies. In films from this period (Fear Strikes Out, The Three Faces of Eve, David and Lisa, the biopic Freud), psychiatrists and psychologists are treated as competent, compassionate, and even likable. In David and Lisa (1960) Dr Swinford (Howard Da Silva) is shown as wise and caring, yet vulnerable and human, as he treats the hospitalized young patients.
The Golden Age didn't last long. In the 1960s and 1970s, mental health professionals were subjected to the skepticism that was applied to all established institutions. The portrayal of the quack returned, this time with a harsher edge, and more serious criticisms of basic psychiatric motives were advanced in films like the Oscar-winning One Flew Over the Cuckoo's Nest.22
Another way to understand how Hollywood looks at psychologists is through patterns, not only within time periods but in the types of characters presented over time. A triad of cinematic shrink stereotypes has been described:23
Dr Dippy: This type is primarily characterized by comic foolishness. These characters are meant to be laughed at or dismissed as inept. Dr Montague (Harvey Korman) in Mel Brooks's High Anxiety and Dr Marvin (Richard Dreyfuss) in What About Bob? are classic examples.
Dr Evil: This stereotype reflects psychologists who use their knowledge of the human mind to abuse, manipulate, or otherwise harm patients for personal gain. The murdering, cannibalistic Hannibal Lecter (Anthony Hopkins) in The Silence of the Lambs has become the iconic example of Dr Evil in modern cinema. Nurse Ratched (Louise Fletcher) in One Flew Over the Cuckoo's Nest may not seem quite as evil, but the movie emphasizes her domineering motivations. Dr Cawley in Shutter Island, director of a menacing 1950s insane asylum, appears to be a Dr Evil despite his claims of progressiveness. Compared to the Dr Dippy subtype, such mental health professionals seem quite formidable, even though their moral compasses are decidedly off kilter.
Dr Wonderful: These characters are competent, caring, and effective in their treatment. There seem to be no limits to what they will do to help their patients. While prevalent during the Golden Age, these noble characters did not disappear completely. Dr Berger (Judd Hirsch) in Ordinary People is a reference point for this kind of therapist: the good doctor thinks nothing of coming to his client's house to do emergency, and ultimately transforming, counseling.
Other types have been added to the list. Over the past 20 years movies have seen many depictions of “the Wounded Healers”24—professionals who may share many characteristics of Dr Wonderful but have psychological issues of their own that interfere with their work. In Good Will Hunting Dr Sean Maguire is a wounded healer who valiantly attempts to treat Will (Matt Damon) while struggling with grief over the death of his wife. Such movies may seek to deflate grandiose notions about the perceived superiority of mental health practitioners by portraying them as flawed (or human) individuals.
Another prominent characteristic of movie shrinks is an unusually common tendency to engage in sexual relationships with their patients; this type could be labeled Dr Sexy25 or Dr Line-Crosser.26 In psychological thrillers, therapists who have sex with their patients share an element of Dr Evil in that they are coldly exploitative,27 but in many mainstream movies, such therapists typically fall in love with their patients.28 Many movies have featured female therapists are who young, sexualized (in how they dress), and lonely. These characters experience personal transformation when they fall in love with their male clients.29 Hitchcock's Spellbound is a classic example of this pattern, while The Prince of Tides offers an updated variation—therapist Dr Lowenstein (Barbara Streisand) falls in love with her patient's brother and then engages him in treatment.30 Clearly, whatever fascination filmmakers have with the profession of psychology, it is trumped by their fascination with desirable and desirous women.
As with mental illness, a deeper understanding of the representations of psychotherapy can be gained by considering the underlying dramatic truths that capture the imagination of filmmakers. One way of accomplishing this is by looking at character motivations. What appears to be driving these characters? Are there ways in which the motivations of fictional therapists relate to those of real therapists?
In a systematic study of mental health professionals in the movies, colleagues and I looked at the top 20 US box-office films for each year from 1990--1999.31 We identified 34 films (17% of the films we sampled) featuring mental health professionals. Of these, 58 individual characters were identified (see Appendix A). We then considered whether each character seemed driven by the following: money/prestige; power; love/lust; self-healing; or concern for others. Such representations tended to both distort and reflect reality.
Money/prestige (motivating 52% of characters): In the comic farce What About Bob?, the egotistical Dr Marvin (Richard Dreyfuss) worries excessively about television publicity for his latest pop-psych book while displaying little concern for the neurotic Bob (Bill Murray). Like many professions with relatively high prestige and compensation, mental health professionals are vulnerable to being represented as greedy. In fact, many real mental health providers feel they have a calling to contribute to the common good. From this perspective, Dr Marvin is not a humorous caricature but rather a therapist's nightmarish alter ego.
That said, mental health practice is a profession, one which requires a great deal of training and commitment, and most practitioners want to be well-compensated. At the same time, it has been argued that the failure of some therapists to treat their work as a business can actually undermine treatment by failing to create clearly defined boundaries. While Dr Marvin's callousness is open to disdain, do his nicely appointed office and vacation home by themselves contradict the ambitions of the professional helper?
Power (a motivator of 62% of characters): A deadly three-way power struggle is portrayed in The Silence of the Lambs between Dr Chilton, the scheming director of a maximum security psychiatric hospital, Dr Hannibal Lecter, a brilliant psychiatrist imprisoned for murder and cannibalism, and Clarice Starling, a young FBI agent trying to negotiate between both men to catch a serial killer. Lecter's character is particularly disturbing because he taps into the widespread suspicion that mental health professionals have special “powers” over the human mind.
At the same time, such professionals have power in that they are representatives of socially sanctioned insti
tutions. The most common areas of medical malpractice in treatment settings relate to violations of power.32 From a didactic standpoint, Drs Chilton and Lecter may be understood not simply as libelous to decent psychiatrists, but as exaggerated warnings to mental health professionals everywhere.
Love/lust (which motivates 24% of characters): The quasi-pornographic fantasy Basic Instinct features the provocatively dressed and ethically challenged police psychologist Dr Garner (Jeanne Tripplehorn) who proclaims her love for a detective she has been treating even after he sexually assaults her. Mental health professionals tend to be outraged by these depictions since sexual relationships between practitioners and clients are clearly prohibited by the ethical codes of all the major disciplines.
Nevertheless, psychoanalysis was founded on Freud's observation that sexuality is a primary motive for human behavior. While most modern treatment approaches have decentralized sexuality, mental health treatment remains an intimate experience. Most psychologists report having been sexually attracted to at least one client (although only a small percentage act on this attraction).33 As the psychoanalyst Marshall Edelson has pointed out, it is difficult to forget the importance of erotic feelings in human relationships if one watches many movies.34
Self-healing (a motivator for 26% of the characters): In The Sixth Sense, Dr Malcolm is a successful child psychologist who becomes so depressed and guilt-ridden after one of his patients commits suicide that his marriage is threatened. This variation on the wounded healer motif also emphasizes psychotherapeutic failure.
Real mental health professionals are imperfect. The idea of professionals having preexisting psychological and emotional issues that determine how they engage in their work has been normalized in such concepts as counter-transference. Successful mental health providers must find ways to resolve, bypass, or even constructively use their emotional issues to become better professionals. The Sixth Sense, driven by a surprise ending that forces Dr Malcolm to radically reevaluate his place in the world, dramatizes the real struggles and fears of therapists.
Concern for others (a motivator for 66% of characters): In the comedy Analyze This, Dr Sobel (Billy Crystal) is initially reluctant to treat his Mafioso client, but eventually becomes so committed that he risks his life to help the mobster heal his abusive past. While concern for others appears to be more positive than the other motivations, it is equally open to distortion. The almost unbelievable benevolence and self-sacrifice of some movie professionals establishes selflessness as a requirement of the profession.
At the same time, concern for others is perhaps the one necessary (although not sufficient) requirement for mental health professionals. The importance of empathy is widely understood to be a critical component of successful therapy.35 To an extent, even Hollywood movies recognize this. Despite the prevalence of concern for others as a motivation in Hollywood therapists, the depiction of a superhuman professional (aka Dr Wonderful) was actually quite rare in our sample. The combination of concern for others with a desire for self-improvement may not be an inherently bad combination, an insight that can be witnessed in many movies (even if it requires viewers to look past such dramatic liberties as a breakthrough counseling session conducted in the midst of a gun battle).
Most of our attention to psychological treatment in the movies has focused on psychotherapy. In part, this is because the privacy and intimacy of psychotherapy allows for the revelation of a darker side of humanity, one that is open to either sensitive or salacious treatment. Other treatment modalities don't offer that dramatic flair. For example, the prescription of psychoactive medication—antidepressants like Prozac and antipsychotics like Risperdal—is probably the dominant mental health treatment of the modern age. Yet 1997's As Good as It Gets was the first major movie to depict the effective management of mental health symptoms (obsessive-compulsive disorder) through medication in an outpatient setting.36
When aspects of psychology and psychological treatment other than therapy are presented, they generally capture institutional oppression. Thus, when the use of psychiatric medications in an inpatient setting is depicted, emphasis is exclusively placed on their sedating effects (e.g., Girl, Interrupted). The application of electro-convulsive (or “shock”) therapy pops up occasionally, but these cinematic representations are always brutal (see One Flew Over the Cuckoo's Nest).37 The other explicitly psychological activity which is regularly presented in the media is that of criminal profiler, which emphasizes the ability to understand the mind of serial killers and other criminals.38
The appeal of psychotherapy in film goes beyond its ability to explore provocative topics that preoccupy filmmakers and film audiences. Psychotherapy and narrative film share many qualities—storytelling that is grounded in emotional experience, personal discovery, and, in many cases, striving toward an improved life. It is not surprising, then, that psychotherapy and film have found each other so often.
Closing Shots: The Impact of Representations of Psychology
Representations of psychological disorders and psychological treatment would not attract so much attention from psychologists were it not for concerns about the impact such depictions might have on real-world attitudes toward psychology and whether they may do more harm than good.39 In the cinema of pure fantasy, verisimilitude is rarely a concern (few people worry whether the Orcs in Lord of the Rings are being accurately portrayed). But unlike fantasy monsters, psychology is real, so there is the possibility that the public will take such dramatic representations as the truth.
Representations of people with mental illness are particularly concerning. Surveys have indicated that for many members of the public, most of their knowledge about mental illness comes from the media.40 Otto Wahl is concerned that movies and other media have promulgated a view that the mentally ill are objects of ridicule, violent and dangerous, and fundamentally different from other people.41
I have personally witnessed the public's attitudes toward mental illness in my own undergraduate students. Most are savvy enough to recognize that movies, particularly comedies, exaggerate symptoms, yet their attention to certain phenomena has definitely been heightened by media accounts. When I lecture on schizophrenia, I discuss subtypes, the relatively late onset of the disease, responses to antipsychotic medication, and so on. But inevitably students will blow past these facts and start asking about psychokillers. For some students, the connection between schizophrenia and murder is so strong, they are stunned to learn that many people who carry the diagnosis are able to go about their day-to-day lives quite normally. While students are typically receptive to altering their beliefs, I sometimes wonder how long their enlightenment will last when they are once again faced with the onslaught of popular culture.
The negative impact of depictions of mental illness can also be seen in individuals with psychological disorders. An honors graduate in film studies who was diagnosed with schizophrenia recounted the impact of film representations on her life. Not surprisingly, she is often hesitant to share her diagnosis for fear of being perceived as a “homicidal maniac.” Negative media depictions can be so powerful, she admitted she even occasionally wondered about herself after watching movies, even though she knew better.42
When large-scale studies of the impact of media on perceptions of mental illness have been conducted, the results confirm that both fictional and non-fiction media can have an effect on how viewers perceive mental illness.43 One group of researchers found that when people get most of their information from electronic media, they tend to develop authoritarian attitudes (that is, they believe that people with mental illness should not be treated in the general community).44 When another researcher interviewed groups of individuals about their attitudes toward mental illness, movies like Silence of the Lambs and Psycho were often referenced in association with negative beliefs.45 In yet another study, student attitudes toward mental illness became more negative after viewing One Flew Over the Cuckoo's Nest.46
As we have seen, psy
chologists and filmmakers approach the cinematic representations of madness in very different ways. According to Fleming and Manvell, “For the psychologist madness is primarily something to be quantitatively understood and then cured. For the film artist madness is principally a subject whose depiction provides the darkest and most hidden side of our being.”47 To the extent that distorted depictions of the mentally ill do impact the public perception of mental illness, the appeal for positive and accurate portrayals is understandable.
Still, mental health professionals should not be naïve; we are not in the same business as filmmakers. A psychologist may object to a character's being labeled “manic-depressive” instead of the more modern “bipolar disorder,” while a filmmaker is likely to think that “bipolar” sounds like some kind of geographical term, and prefer the more dramatic “manic-depressive.”
Furthermore, movies do not have to accurately capture diagnostic reality in order to effectively ruminate on the nature of madness. Films capture the behaviors of people that both threaten and fascinate us. At the same time, these representations evoke the possibility of behaviors within ourselves that we fear and/or desire. Psychiatrist Harry Stack Sullivan has stated that “everyone is much more simply human than otherwise.”48 Sullivan's statement is useful when considering any aspect of human diversity, 49 but the appeal for unity is particularly relevant for psychological disorders where examples of diversity are so vivid. The symptoms of these disorders strike many people as bizarre and odd and very different from ourselves. Sullivan's adage can help mitigate the tendency to alienate the afflicted by emphasizing the things that all people share (the desire for friendship, the capacity for love, curiosity about other people, etc.).
Psychology at the Movies Page 7
